VIRAL UVEITIS WITHOUT IMMUNE-DEFICIENCY

Herpes simplex and varicella zoster remain the only confirmed causes of anterior and posterior uveitis in adults without immune deficiency, although evidence exists that cytomegalovirus, Epstein-Barr virus, and parvovirus B19 may also cause some uveitis. Herpetic iridocyclitis has been treated effectively with systemic acyclovir, but treatment to increase the duration of latency between recurrences has not been defined. Systemic acyclovir also reduces the incidence of chronic uveitis following herpes zoster ophthalmicus. Herpes simplex and varicella zoster infections of the posterior segment produce severe necrotizing retinitis. Determination of a specific viral etiology is being attempted in more cases of acute retinal necrosis. Recognition of central nervous system involvement is also increasing. A murine model of herpes simplex necrotizing retinitis has implications for bilateral spread in humans and for the contributions of host immune responses to disease severity. Antiviral treatment does not appear to limit severity but does decrease the rate of bilateral involvement in humans. Improved surgical management of the retinal complications of acute retinal necrosis may improve the final visual outcome in some patients.